prevention of falls in the geriatric patient & the tug test julie smith pa class of 2009...
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Prevention of Falls in the Prevention of Falls in the Geriatric Patient Geriatric Patient
& & the TUG testthe TUG test
Julie SmithJulie Smith
PA Class of 2009PA Class of 2009
Advisor: Professor FahringerAdvisor: Professor Fahringer
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The FactsThe Facts Falls can occur and any age, but drastically rise Falls can occur and any age, but drastically rise
after the age of 65after the age of 65
1/3 of adults over 65 years of age fall each year 1/3 of adults over 65 years of age fall each year in developed countriesin developed countries
Falls are the leading cause of fatal and nonfatal Falls are the leading cause of fatal and nonfatal injuries in people 65 and older in the United injuries in people 65 and older in the United States.States.
The most common serious injuries are head The most common serious injuries are head injuries, wrist fractures, spine fractures, and hip injuries, wrist fractures, spine fractures, and hip fractures.fractures.
60% of falls occur at home, 30% occur in the 60% of falls occur at home, 30% occur in the community and 10% occur in nursing homes or community and 10% occur in nursing homes or other institutions. other institutions.
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More FactsMore Facts Tripping in the home is a cause of many fallsTripping in the home is a cause of many falls
Falls account for 80% of all injury related Falls account for 80% of all injury related admissions to the hospital of people over 65 admissions to the hospital of people over 65 years of age worldwide years of age worldwide
Fractures accounted for only 35% of non-fatal Fractures accounted for only 35% of non-fatal injuries but 61% of the total costs related to injuries but 61% of the total costs related to fallsfalls
Lower extremity injuries > Upper extremity injuries Lower extremity injuries > Upper extremity injuries
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Hip Fracture StatisticsHip Fracture Statistics 90% of 352,000 hip fractures in the United States each year 90% of 352,000 hip fractures in the United States each year
are the result of a fall. By the year 2050, there will be an are the result of a fall. By the year 2050, there will be an estimated 650,000 hip fractures annually. This is nearly estimated 650,000 hip fractures annually. This is nearly 1,800 hip fractures a day. 1,800 hip fractures a day.
The cost of hip fracture care averages $35,000 per The cost of hip fracture care averages $35,000 per patient. patient.
Women have two to three times as many hip fractures as Women have two to three times as many hip fractures as men. men.
White, post-menopausal women have a 1 in 7 chance of hip White, post-menopausal women have a 1 in 7 chance of hip fracture during a lifetime. The rate of hip fracture increases fracture during a lifetime. The rate of hip fracture increases at age 50, doubling every five to six years. at age 50, doubling every five to six years.
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More Hip Fracture StatisticsMore Hip Fracture Statistics
The risk of hip fracture for women 5'8 The risk of hip fracture for women 5'8 " or taller is twice that of women who " or taller is twice that of women who are under 5'2. " are under 5'2. "
Nearly one half of women who reach Nearly one half of women who reach age 90 have suffered a hip fracture. age 90 have suffered a hip fracture.
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The Really Scary StatisticsThe Really Scary Statistics
* ONLY 25% of hip fracture patients will * ONLY 25% of hip fracture patients will make a full recoverymake a full recovery
* 40% will require nursing home care* 40% will require nursing home care
* 50% will need a cane or walker* 50% will need a cane or walker
And ….And ….
* 24% of those over age 50 will die * 24% of those over age 50 will die within 12 months. within 12 months.
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Who is Falling?Who is Falling?
Women fall 2-3 times more than menWomen fall 2-3 times more than men
Women’s healthcare costs associated Women’s healthcare costs associated with falls were 2-3 times higher than with falls were 2-3 times higher than men’s costs overallmen’s costs overall
15% of people who have fallen, fall 15% of people who have fallen, fall againagain
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Why do we Fall?Why do we Fall?
Home Hazards, throw rugsHome Hazards, throw rugs #1 Reason in the home to fall….. is#1 Reason in the home to fall….. is TrippingTripping or slipping due to loss of footing or slipping due to loss of footing
or traction or traction Medication side effects, iatrogenicMedication side effects, iatrogenic Reduced muscle strength Reduced muscle strength Poor vision/Ear dysfunctions/Vertigo Poor vision/Ear dysfunctions/Vertigo Balance problemsBalance problems Osteoporosis? Fracture then fall?Osteoporosis? Fracture then fall?
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Geriatric robberyGeriatric robbery
Loss of quality of lifeLoss of quality of life Loss of independenceLoss of independence Premature entrance to a nursing Premature entrance to a nursing
homehome Premature deathPremature death Extremely expensive>many can lose Extremely expensive>many can lose
house, savings, drivers license, etc…house, savings, drivers license, etc…
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Risk FactorsRisk Factors Age and GenderAge and Gender HeredityHeredity> DEXA Scan to r/o osteopenia > DEXA Scan to r/o osteopenia
and osteoporosisand osteoporosis Women Women > Men> Men Home hazardsHome hazards MedicationMedication, regularly review necessary , regularly review necessary
and unnecessary medsand unnecessary meds HistoryHistory of Falls of Falls Peripheral NeuropathyPeripheral Neuropathy Ear/EyeEar/Eye dysfunctions dysfunctions
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What can we do in the office?What can we do in the office?
• AskAsk about fall hx, screen in about fall hx, screen in patient hx formspatient hx forms
• ReviewReview Medication list Medication list
• AssessAssess fall risk fall risk
• Refer Refer to Physical Therapyto Physical Therapy
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Assessing Fall RiskAssessing Fall Risk
Can we assess Fall risk?Can we assess Fall risk?
Is it accurate? Is it functional?Is it accurate? Is it functional?
Tinnetti TestTinnetti Test Berg Test -balance Berg Test -balance Timed Up & GoTimed Up & Go
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The Timed Up and Go TestThe Timed Up and Go Test aka “ TUG“ Test aka “ TUG“ Test
Quick & Easy for provider & patientQuick & Easy for provider & patient
Need : Need : a chair with armsa chair with arms a person, and a person, and 10 feet measured out10 feet measured out
-consider hallway-consider hallwayHow to do it: How to do it:
Patient sits in a chair with arms, you ask them to rise from the chair, walk 10 feet, Patient sits in a chair with arms, you ask them to rise from the chair, walk 10 feet, turn around, walk back to the chair and sit back down.turn around, walk back to the chair and sit back down.Patient is allowed to use a walking aid and glasses if normally used.Patient is allowed to use a walking aid and glasses if normally used.
Video: Video: www.youwww.youtube.comtube.com
http://www.homehealthquality.org/hh/hha/interventionpackages/falls_prevention.aspx http://www.homehealthquality.org/hh/hha/interventionpackages/falls_prevention.aspx
Goal: Less than 12 seconds = independentGoal: Less than 12 seconds = independent
>12 seconds to complete= Risk for Falls>12 seconds to complete= Risk for Falls
TUG with an obstacleTUG with an obstacle
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Additional TestAdditional Test
Single Leg StanceSingle Leg Stance
• 30 seconds is a general goal30 seconds is a general goal
• Try eyes open and closedTry eyes open and closed
• Everyone should try this!!Everyone should try this!!
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Fall Prevention TipsFall Prevention Tips1. Take a 1. Take a Fall HistoryFall History
2. 2. Medication reviewMedication review: : • benzodiazepinesbenzodiazepines• sleeping aidssleeping aids• neurolepticsneuroleptics• antidepressantsantidepressants• seizure medsseizure meds
3. 3. TUG TESTTUG TEST – shoot for <12 sec – shoot for <12 sec If >12 sec, walking aid, PT, If >12 sec, walking aid, PT,
patient educationpatient education
4. 4. Visual acuity Visual acuity <20/60 puts at <20/60 puts at risk for depth perception risk for depth perception deficits. Refer if neededdeficits. Refer if neededEar checksEar checks- ear infections, - ear infections, vertigo symptomsvertigo symptoms
5. 5. Bone densityBone density: Family hx, : Family hx, Dexa scans and Treat:Dexa scans and Treat:Calcium, Vit D, FosamaxCalcium, Vit D, Fosamax
6. 6. Home hazard safetyHome hazard safety - - communication with patient and communication with patient and family to eliminate hazardsfamily to eliminate hazards
7.7.Gait dysfunctionsGait dysfunctions: Abnormal : Abnormal gait, improper use of walking aids gait, improper use of walking aids lead to falls, Refer to PTlead to falls, Refer to PT
88.. MusculoskeletalMusculoskeletal
abnormalities/weaknessabnormalities/weakness,, Refer to PT for strengtheningRefer to PT for strengthening
9. 9. Impaired neurological Impaired neurological examexam, , DM patients with DM patients with peripheral neuropathies,peripheral neuropathies,
- Refer for EMG, PT- Refer for EMG, PT
10. 10. Medic AlertsMedic Alerts especially for especially for those living alonethose living alone
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Patient EducationPatient Education Eliminate or secure all throw rugs Eliminate or secure all throw rugs
with non-slip padswith non-slip pads
Assess lighting, and have Assess lighting, and have nightlights for evening bathroom nightlights for evening bathroom tripstrips
Install hand rails in bathrooms Install hand rails in bathrooms and stairwaysand stairways
Remove clutter on floors and Remove clutter on floors and stairways, cords especiallystairways, cords especially
Always wear shoes or slippers Always wear shoes or slippers with rubber soleswith rubber soles
Non-skid surface in bathtubs and Non-skid surface in bathtubs and showersshowers
Evaluate thresholds for potential Evaluate thresholds for potential tripping dangerstripping dangers
Shower chairs and bedside Shower chairs and bedside commodes are helpfulcommodes are helpful
Easy access to contact and Easy access to contact and emergency numbersemergency numbers
Slow changes in positions from Slow changes in positions from lying to sitting to standinglying to sitting to standing
Sit in chairs with armsSit in chairs with arms
No high heels ladies!No high heels ladies!
Proper use of walking aids include Proper use of walking aids include actually using themactually using them
Ear infections and eye problems Ear infections and eye problems can lead to fallscan lead to falls
Report any side effects from Report any side effects from medications involving dizzinesmedications involving dizzines
Stay active and practice a good Stay active and practice a good nutritional dietnutritional diet
Take medicine as instructed Take medicine as instructed
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The Bottom LineThe Bottom Line IT’S A BAD THING!!IT’S A BAD THING!!
BUT, YOU CAN MAKE BUT, YOU CAN MAKE A DIFFERENCEA DIFFERENCE
GIVE OUR ELDERS A GIVE OUR ELDERS A CHANCE TO TAKE CHANCE TO TAKE THE RIGHT STEPSTHE RIGHT STEPS
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ReferencesReferences 1. Demura S, Uchiyama M. Proper assessment of the falling risk in the elderly by a physical mobility 2. Elley CR, Robertson MC, Kerse 1. Demura S, Uchiyama M. Proper assessment of the falling risk in the elderly by a physical mobility 2. Elley CR, Robertson MC, Kerse
NM, Garrett S, McKinlay E, Lawton B, et al. Falls assessment clinical trial (FACT):design, interventions, recruitment strategies, and NM, Garrett S, McKinlay E, Lawton B, et al. Falls assessment clinical trial (FACT):design, interventions, recruitment strategies, and participant characteristics. BMC Public Health 2007, 7:185. available from:http://www.biomedcentral.com/1471-participant characteristics. BMC Public Health 2007, 7:185. available from:http://www.biomedcentral.com/1471-2458-7-185.2458-7-185.
3. Fatalities and injuries from falls among older adults---United States, 1993-2003 and 2001-2005. MMWR Weekly Report Nov. 17, 3. Fatalities and injuries from falls among older adults---United States, 1993-2003 and 2001-2005. MMWR Weekly Report Nov. 17, 206/55(45);1221-1224.206/55(45);1221-1224.
4. Healey F, Monro A, Cockram A, Adams V, Heseltine D. Using targeted risk factor reduction to prevent falls in older in-patients:a 4. Healey F, Monro A, Cockram A, Adams V, Heseltine D. Using targeted risk factor reduction to prevent falls in older in-patients:a randomized controlled trial. Age and Ageing 2004;33:390-395.randomized controlled trial. Age and Ageing 2004;33:390-395.
5. Kannus P, Khan KM, Lord SR. Preventing falls among elderly people in the hospital environment. MJA 2006;184 (8):371-373.5. Kannus P, Khan KM, Lord SR. Preventing falls among elderly people in the hospital environment. MJA 2006;184 (8):371-373. 6. Laessoe U, Hoeck GC, Simonsen O, Sinkjaer T, Voigt M. Fall risk in an active elderly population-Can it be assessed? Journal of 6. Laessoe U, Hoeck GC, Simonsen O, Sinkjaer T, Voigt M. Fall risk in an active elderly population-Can it be assessed? Journal of
Negative Results in BioMed 2007, 6:2.Negative Results in BioMed 2007, 6:2. 7. Lord SR, Menz HB, Sherrington C. Home environment risk factors for falls in older people and the efficacy of home modifications. 7. Lord SR, Menz HB, Sherrington C. Home environment risk factors for falls in older people and the efficacy of home modifications.
Age and Ageing 2006; 35-S2 ii55-ii59.Age and Ageing 2006; 35-S2 ii55-ii59. 8. Mansfield A, Peters A, LLiu B, Maki B. A perturbation-based balance training program for older adults:study protocol for a 8. Mansfield A, Peters A, LLiu B, Maki B. A perturbation-based balance training program for older adults:study protocol for a
randomized controlled trial. BMC Geriatrics 2007, 7:12. available from :http:/www.biomedcentral.com/1471-2318/7/12.randomized controlled trial. BMC Geriatrics 2007, 7:12. available from :http:/www.biomedcentral.com/1471-2318/7/12. 9. Melzer I, Benjuya N, Kaplanski J. Postural stability in the elderly:a comparison between fallers and non-fallers. Age and Ageing 9. Melzer I, Benjuya N, Kaplanski J. Postural stability in the elderly:a comparison between fallers and non-fallers. Age and Ageing
2004;33;602-607.2004;33;602-607. 10. Nordvall H, Gunhild Glanberg-Persson, Lysholm J. Are distal radius fractures due to fragility or falls? Acta Orthopaedica 2007;78:10. Nordvall H, Gunhild Glanberg-Persson, Lysholm J. Are distal radius fractures due to fragility or falls? Acta Orthopaedica 2007;78:
(2):271-277.(2):271-277. 11. Ozcan A, Donat H, Gelecedk N, Ozdirenc M, Karadibak D. The relationship between risk factors for falling and the quality of life in 11. Ozcan A, Donat H, Gelecedk N, Ozdirenc M, Karadibak D. The relationship between risk factors for falling and the quality of life in
older adults. BMC Public Health 2005, 5:90. available from:http://www.biomedcentral.com/1471-2458//5/90older adults. BMC Public Health 2005, 5:90. available from:http://www.biomedcentral.com/1471-2458//5/90 12. Peeters GE, deVries OJ, Elders PJ, Pluijm SM, Bouter LM, Lips P. Prevention of fall incidents in patients with a high risk of 12. Peeters GE, deVries OJ, Elders PJ, Pluijm SM, Bouter LM, Lips P. Prevention of fall incidents in patients with a high risk of
falling:design of a randomized controlled trial with an economic evaluation of the effect of multidisciplinary transmural care. BMC falling:design of a randomized controlled trial with an economic evaluation of the effect of multidisciplinary transmural care. BMC Ger. 2007, 7:15. available from :http://www.biomedcentral.com/1471-2318/7/15.Ger. 2007, 7:15. available from :http://www.biomedcentral.com/1471-2318/7/15.
Shinichi Demura and Masanobu Uchiyama “Proper Assessment of the Falling Risk in the Elderly by a Physical Mobility Test with an Shinichi Demura and Masanobu Uchiyama “Proper Assessment of the Falling Risk in the Elderly by a Physical Mobility Test with an Obstacle”. Obstacle”. Tohoku J. Exp. Med.Tohoku J. Exp. Med., Vol. , Vol. 212212, 13-20 (2007) ., 13-20 (2007) .
13. Stenvall M, Olofsson B, Lundstrom M, Englund U, Borssen B, Svensson O, et al. A multidisciplinary, multifactorial intervention 13. Stenvall M, Olofsson B, Lundstrom M, Englund U, Borssen B, Svensson O, et al. A multidisciplinary, multifactorial intervention program reduceds postoperative falls and injuries after femoral neck fracture. Osteoprorosis Int. 2007, 18:167-175.program reduceds postoperative falls and injuries after femoral neck fracture. Osteoprorosis Int. 2007, 18:167-175.
14. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj. Prev. 2006;12;290-14. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj. Prev. 2006;12;290-295.295.
15. van Schoor NM, Smit JH, Twisk JR, Bouter LM, Lips P. Prevention of Hip fractures by external hip protectors. JAMA, April 16, 2003-15. van Schoor NM, Smit JH, Twisk JR, Bouter LM, Lips P. Prevention of Hip fractures by external hip protectors. JAMA, April 16, 2003-vol289, No. 15, p1957-1962.vol289, No. 15, p1957-1962.
16. Vassallo M, Sharma JC, Briggs RSJ, Allen SC. Characteristics of early fallers on elderly patient rehabilitation wards. Age and 16. Vassallo M, Sharma JC, Briggs RSJ, Allen SC. Characteristics of early fallers on elderly patient rehabilitation wards. Age and Ageing 2003;32:338-342.Ageing 2003;32:338-342.
http://orthoinfo.aaos.org/topic.cfm?topic=A00121http://orthoinfo.aaos.org/topic.cfm?topic=A00121 VIDEO http://www.youtube.com/watch?v=xx1XCpglOcVIDEO http://www.youtube.com/watch?v=xx1XCpglOc